Provider Demographics
NPI:1780242214
Name:PRECISION BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:PRECISION BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KEYORKA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-615-5549
Mailing Address - Street 1:14100 MONTFORT DR
Mailing Address - Street 2:STE 1236
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-3021
Mailing Address - Country:US
Mailing Address - Phone:504-615-5549
Mailing Address - Fax:
Practice Address - Street 1:14100 MONTFORT DR
Practice Address - Street 2:STE 1236
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-3021
Practice Address - Country:US
Practice Address - Phone:504-615-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health